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Dennis Hong

Publications and source records attributed to Dennis Hong.

8 recordsLinked to original sources
PubMed2005

Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass for morbid obesity: a single-institution comparison study of early results.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are common surgical procedures for morbid obesity, but few studies have compared LRYGB and LAGB. All patients who underwent LRYGB and LAGB by a single surgeon at Legacy Health System were identified from a prospectively maintained database. Preoperatively, most patients were allowed to choose between LRYGB and LAGB. Age, sex, body mass index (BMI), complications, mortality, and weight loss were examined. From October 2000 to November 2003, 219 patients underwent LRYGB and 154 patients underwent LAGB. Mean preoperative BMI was 49.5+/-6.6 and 50.9+/-9.4 kg/m2, respectively (P=0.10). Mean age was 42+/-9 and 47+/-11 years (P<0.001). The LAGB group had a higher proportion of male patients (21% versus 7%, P<0.001). Patients undergoing LRYGB had longer operative times (134 versus 76 minutes, P<0.001), more blood loss (43 versus 28 ml, P<0.01), and longer hospital stays (2.6 versus 1.3 days, P<0.001). Excess weight loss was 35% for LRYGB versus 19% for LAGB at 3-month follow-up (P<0.001), 49% versus 25% at 6 months (P<0.001), 64% versus 36% at 12 months (P<0.001), 70% versus 45% at 24 months (P<0.001), and 60% versus 57% at 36 months (P=0.85). Major complications occurred in 7% and 6% (P=0.58) and minor complications occurred in 18% and 20% (P=0.65) of patients, respectively. Reoperation occurred in 21 patients (10%) after LRYGB and 31 (20%) patients after LAGB (P<0.01). Of patients undergoing reoperation, eight (38%) LRYGB patients and one (3%) LAGB patient required open laparotomy. One death occurred in each group. Patients undergoing laparoscopic adjustable gastric banding have shorter operative times, less blood loss, and shorter hospital stays compared with laparoscopic gastric bypass patients. The incidence of major and minor complications is similar; however, morbidity after LRYGB is potentially greater and the reoperation rate is higher in the LAGB group. Early weight loss is greater with gastric bypass, but the difference appears to diminish over time.

Female↗
PubMed2004

Laparoscopic placement of hepatic artery infusion pumps: technical considerations and early results.

BACKGROUND: Laparoscopic hepatic artery infusion pump (LHAIP) placement is a novel treatment option for patients with colorectal liver metastases. This study investigates technical difficulties with regard to variant hepatic arteries and the preliminary outcomes for patients treated with LHAIP placement. METHODS: Between March 1998 and January 2003, 38 patients with colorectal metastases confined to the liver, 35 (92%) of who had prior systemic chemotherapy that failed, were treated with LHAIP. RESULTS: Twelve patients (32%) had LHAIP placement only, and 26 (68%) had pump placement combined with laparoscopic radiofrequency ablation (LRFA; 24 patients) and/or liver resection (2 patients). Variant hepatic arterial (HA) anatomy was present in 18 patients (47%). The presence of a variant HA did not increase pump complications, operative time, or blood loss (P >/=.20) or decrease the functional time of pump use (P =.91) in comparison with normal anatomy. In all patients with a variant HA, laparoscopic ligation of the variant vessel and/or cannulation of nongastroduodenal artery resulted in complete hepatic perfusion. Three misperfusions identified intraoperatively with use of methylene blue injection were corrected by laparoscopic ligation (two) or postoperative angioembolization (one). Postoperative pump radionuclide flow studies confirmed isolated hepatic artery infusion in all cases. There was a 13% pump-related complication rate. During a median follow-up of 11 months (0.5 to 35.5 months), the actuarial rate of overall survival was 47% and the estimated median survival time was 17.5 months. CONCLUSIONS: LHAIP placement is technically feasible, and variant HA is not associated with increased pump complications or decreased pump functional time.

Aged↗
PubMed2004

Postoperative objective outcomes for upright, supine, and bipositional reflux disease following laparoscopic nissen fundoplication.

HYPOTHESIS: Traditionally, patients with gastroesophageal reflux disease fall into 3 categories based on 24-hour pH testing and the clinical occurrence of their acid exposure. Patients with upright reflux are believed to do worse following surgery compared with supine or bipositional reflux patients. We assessed objective postoperative outcomes for patients with upright, supine, and bipositional reflux following laparoscopic Nissen fundoplication to determine if there is a category of refluxing patient who should be counseled against antireflux surgery. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Esophageal physiology laboratory at a tertiary care teaching hospital. PATIENTS: A total of 225 patients (supine, 45; upright, 92; bipositional, 88) with preoperative and postoperative 24-hour pH measurements, manometry results, and standardized symptom assessment forms were included in the study. INTERVENTIONS: A Nissen fundoplication was performed based on 24-hour pH and manometry result. Esophageal manometry was performed with a water-perfused system, and 24-hour pH was measured with a digital capture device. MAIN OUTCOME MEASURES: Preoperative and postoperative symptom correlation, 24-hour pH, and manometric variables. RESULTS: There was a significant difference in preoperative symptom correlation between groups. Patients with bipositional reflux disease have significantly worst reflux disease (percentage of time with a pH <4, total number of reflux episodes, longest reflux episode, and Johnson-DeMeester score) and the weakest preoperative lower esophageal sphincter pressure. Postoperative symptom correlation was low among all 3 groups. There was no significant difference in postoperative 24-hour pH or manometry among groups. Success following surgery was achieved in 73.3% with supine reflux, 80.4% with upright reflux, and 75.0% with bipositional reflux. CONCLUSIONS: Patients with bipositional reflux have the most severe disease. Supine, upright, and bipositional reflux patients perform equally well following laparoscopic fundoplication as defined by objective outcome criteria.

Adult↗
PubMed2004

Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results.

OBJECTIVE: Preoperative 24-hour pH testing is controversial in surgical patients who have symptomatic gastroesophageal reflux disease (GERD) and endoscopic evidence of esophagitis. The objective of this study was to compare the clinical outcomes of Nissen fundoplication for symptomatic reflux between patients with normal and abnormal preoperative pH testing. METHODS: Patients were selected from a prospective database of patients who underwent laparoscopic esophageal procedures between January 1997 and December 2001 at our institution. Only patients having typical symptoms of GERD (heartburn and/or reflux), preoperative pH testing, manometry, and endoscopy and who had at least 6 months of post-operative follow-up were included in the study. Fifteen patients had normal preoperative DeMeester scores (DMS) (median 11.4, range 3.3 to 14.7). These were compared with 208 consecutive patients having abnormal preoperative DMS (median 49.6, range 15.2 to 250). Logistic regression modeling was performed to identify variables significant for poor outcome. Differences between means were tested using appropriate parametric or nonparametric tests. RESULTS: There were no statistically significant differences in demographics, preoperative symptom score (mean 2.9 +/- 1.1 vs. 3.1 +/- 0.68, P = 0.30), or preoperative grade of esophagitis (P = 0.37) between the 2 groups. After a median follow-up of 8.8 months (range 6 to 36), 6 (40%) of the patients having normal preoperative DMS and 17 (8.1%) of the patients having abnormal preoperative DMS continued to have typical GERD symptoms (P <0.01, B error = 0.02). The most significant factor for poor outcome in the regression model was normal preoperative pH (odds ratio 9.02, P <0.01). CONCLUSIONS: Symptomatic GERD patients with normal preoperative 24-hour pH test results have significantly worse subjective outcomes after Nissen fundoplication compared with patients having abnormal preoperative pH test results. To minimize poor symptomatic outcomes after antireflux surgery, a policy of routine preoperative pH testing is advised.

Aged↗
PubMed2002

Prospective comparison of laparoscopic versus open resection for benign colorectal disease.

Laparoscopic surgery is not being applied in a widespread manner in the management of benign or malignant colorectal disorders. This is a prospective comparison of 279 patients who underwent elective colorectal surgery. Colorectal diseases included inflammatory bowel, diverticular disease, colonic inertia, polyps, and rectal prolapse. Data included 136 patients who underwent laparoscopic surgery (mean age, 51.3 years) and 143 who underwent open surgery (mean age, 56.0 years). Thirteen patients' procedures were converted to open, but their results were included in the laparoscopic surgery group. There was no significant difference in operative time, postoperative complications, morbidity, or mortality between the laparoscopic and open surgery groups. More patients in the laparoscopic group had significant cardiac disease (6.0%, laparoscopic; 0.7%, open; = 0.01). More patients in the open group had undergone previous gastrointestinal surgery (3.7%, laparoscopic; 11.2%, open; = 0.02). The laparoscopic group used less postoperative analgesia and resumed oral feeding quicker ( < 0.05). In addition, time to first flatus and bowel movement was faster ( < 0.05), and the length of postoperative hospital stay (7.7 +/- 15.8 versus 11.0 +/- 8.3; = 0.03) was shorter in the laparoscopic surgery group. There are significant advantages in postoperative recovery with the laparoscopic technique. If proven to be cost-effective, laparoscopic colorectal surgery for benign diseases should become the standard of surgical care.

Adult↗
PubMedDate not supplied

Mechanical ventilation: what have we learned?

Mechanical ventilation is the second most frequently performed therapeutic intervention after treatment for cardiac arrhythmias in intensive care units today. Countless lives have been saved with its use despite being associated with a greater than 30% in-hospital mortality rate. As life expectancies increase and people with chronic illnesses survive longer, artificial support with mechanical ventilation is also expected to rise. In one survey, over half of senior internal medicine residents reported their training on mechanical ventilation as inadequate, whereas the majority of critical care nurses reported having received no formal education on its use. Technological advances resulting in the availability of sleeker ventilators with graphic waveform displays and new modes of ventilation have challenged the bedside clinicians to incorporate this new data along with evidenced-based research into their daily practice. A review of current thoughts on mechanical ventilation and weaning is presented.

Critical Care↗
PubMedDate not supplied

Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese.

BACKGROUND: Obesity is an epidemic in the USA. Many disorders are associated with obesity including gastroesophageal reflux disease (GERD). However, the prevalence of GERD and esophageal motility disorders in the morbidly obese population is unclear. METHODS: During evaluation for bariatric surgery, 61 morbidly obese patients underwent preoperative 24-hr pH and esophageal manometry. A single reviewer evaluated all 24-hr pH and manometric tracings. Johnson-DeMeester score >14.7 was considered diagnostic of GERD. Manometric criteria for motility disorders were from published values. All values are given as mean +/- SD. RESULTS: Mean age was 44.4 + 10.3 years. 55 of the patients (90%) were female. Mean BMI was 50.1 +/- 7.2 kg/m(2). 23 patients (38%) complained of GERD symptoms (reflux and/or heartburn). 1 patient (2%) complained of noncardiac chest pain. Mean Johnson-DeMeester score was 19.6 +/- 17.8. Mean intragastric and intrabolus pressures were both elevated (8.3 +/- 1.6 mmHg and 15 +/- 9 mmHg). 33 patients (54%) had abnormal manometric findings: 10 had a mechanically defective LES, 11 had a hypertensive LES, 2 had diffuse esophageal spasm, 3 had nutcracker esophagus,1 had ineffective esophageal disorder and 14 had nonspecific esophageal motility disorder. Some patients had more than one disorder. 20 patients (33%) had significantly elevated (>180 mmHg) contraction amplitudes at the most distal channel (210.0 +/- 28.7 mmHg). CONCLUSIONS: Prevalence of manometric abnormalities in the morbidly obese is high. Presence of a nut cracker-like distal esophagus in the morbidly obese is significant and warrants further evaluation.

Adult↗